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Abstract ObjectiveAnterior temporal lobectomy (ATL) is a widely performed and successful intervention for drug‐resistant temporal lobe epilepsy (TLE). However, up to one third of patients experience seizure recurrence within 1 year after ATL. Despite the extensive literature on presurgical electroencephalography (EEG) and magnetic resonance imaging (MRI) abnormalities to prognosticate seizure freedom following ATL, the value of quantitative analysis of visually reviewed normal interictal EEG in such prognostication remains unclear. In this retrospective multicenter study, we investigate whether machine learning analysis of normal interictal scalp EEG studies can inform the prediction of postoperative seizure freedom outcomes in patients who have undergone ATL. MethodsWe analyzed normal presurgical scalp EEG recordings from 41 Mayo Clinic (MC) and 23 Cleveland Clinic (CC) patients. We used an unbiased automated algorithm to extract eyes closed awake epochs from scalp EEG studies that were free of any epileptiform activity and then extracted spectral EEG features representing (a) spectral power and (b) interhemispheric spectral coherence in frequencies between 1 and 25 Hz across several brain regions. We analyzed the differences between the seizure‐free and non–seizure‐free patients and employed a Naïve Bayes classifier using multiple spectral features to predict surgery outcomes. We trained the classifier using a leave‐one‐patient‐out cross‐validation scheme within the MC data set and then tested using the out‐of‐sample CC data set. Finally, we compared the predictive performance of normal scalp EEG‐derived features against MRI abnormalities. ResultsWe found that several spectral power and coherence features showed significant differences correlated with surgical outcomes and that they were most pronounced in the 10–25 Hz range. The Naïve Bayes classification based on those features predicted 1‐year seizure freedom following ATL with area under the curve (AUC) values of 0.78 and 0.76 for the MC and CC data sets, respectively. Subsequent analyses revealed that (a) interhemispheric spectral coherence features in the 10–25 Hz range provided better predictability than other combinations and (b) normal scalp EEG‐derived features provided superior and potentially distinct predictive value when compared with MRI abnormalities (>10% higher F1 score). SignificanceThese results support that quantitative analysis of even a normal presurgical scalp EEG may help prognosticate seizure freedom following ATL in patients with drug‐resistant TLE. Although the mechanism for this result is not known, the scalp EEG spectral and coherence properties predicting seizure freedom may represent activity arising from the neocortex or the networks responsible for temporal lobe seizure generation within vs outside the margins of an ATL. 

Abstract Electrophysiologic disturbances due to neurodegenerative disorders such as Alzheimer’s disease and Lewy Body disease are detectable by scalp EEG and can serve as a functional measure of disease severity. Traditional quantitative methods of EEG analysis often require an a-priori selection of clinically meaningful EEG features and are susceptible to bias, limiting the clinical utility of routine EEGs in the diagnosis and management of neurodegenerative disorders. We present a data-driven tensor decomposition approach to extract the top 6 spectral and spatial features representing commonly known sources of EEG activity during eyes-closed wakefulness. As part of their neurologic evaluation at Mayo Clinic, 11 001 patients underwent 12 176 routine, standard 10–20 scalp EEG studies. From these raw EEGs, we developed an algorithm based on posterior alpha activity and eye movement to automatically select awake-eyes-closed epochs and estimated average spectral power density (SPD) between 1 and 45 Hz for each channel. We then created a three-dimensional (3D) tensor (record × channel × frequency) and applied a canonical polyadic decomposition to extract the top six factors. We further identified an independent cohort of patients meeting consensus criteria for mild cognitive impairment (30) or dementia (39) due to Alzheimer’s disease and dementia with Lewy Bodies (31) and similarly aged cognitively normal controls (36). We evaluated the ability of the six factors in differentiating these subgroups using a Naïve Bayes classification approach and assessed for linear associations between factor loadings and Kokmen short test of mental status scores, fluorodeoxyglucose (FDG) PET uptake ratios and CSF Alzheimer’s Disease biomarker measures. Factors represented biologically meaningful brain activities including posterior alpha rhythm, anterior delta/theta rhythms and centroparietal beta, which correlated with patient age and EEG dysrhythmia grade. These factors were also able to distinguish patients from controls with a moderate to high degree of accuracy (Area Under the Curve (AUC) 0.59–0.91) and Alzheimer’s disease dementia from dementia with Lewy Bodies (AUC 0.61). Furthermore, relevant EEG features correlated with cognitive test performance, PET metabolism and CSF AB42 measures in the Alzheimer’s subgroup. This study demonstrates that data-driven approaches can extract biologically meaningful features from population-level clinical EEGs without artefact rejection or a-priori selection of channels or frequency bands. With continued development, such data-driven methods may improve the clinical utility of EEG in memory care by assisting in early identification of mild cognitive impairment and differentiating between different neurodegenerative causes of cognitive impairment. 

Identifying abnormal patterns in electroencephalography (EEG) remains the cornerstone of diagnosing several neurological diseases. The current clinical EEG review process relies heavily on expert visual review, which is unscalable and error-prone. In an effort to augment the expert review process, there is a significant interest in mining population-level EEG patterns using unsupervised approaches. Current approaches rely either on two-dimensional decompositions (e.g., principal and independent component analyses) or deep representation learning (e.g., auto-encoders, self-supervision). However, most approaches do not leverage the natural multi-dimensional structure of EEGs and lack interpretability. In this study, we propose a tensor decomposition approach using the canonical polyadic decomposition to discover a parsimonious set of population-level EEG patterns, retaining the natural multi-dimensional structure of EEG recordings (time×space×frequency) . We then validate their clinical value using a cohort of patients with varying stages of cognitive impairment. Our results show that the discovered patterns reflect physiologically meaningful features and accurately classify the stages of cognitive impairment (healthy vs mild cognitive impairment vs Alzheimer's dementia) with substantially fewer features compared to classical and deep learning-based baselines. We conclude that the decomposition of population-level EEG tensors recovers expert-interpretable EEG patterns that can aid in studying smaller specialized clinical cohorts. 

The recent availability of large datasets in bio-medicine has inspired the development of representation learning methods for multiple healthcare applications. Despite advances in predictive performance, the clinical utility of such methods is limited when exposed to real-world data. This study develops model diagnostic measures to detect potential pitfalls before deployment without assuming access to external data. Specifically, we focus on modeling realistic data shifts in electrophysiological signals (EEGs) via data transforms and extend the conventional task-based evaluations with analyses of a) the model's latent space and b) predictive uncertainty under these transforms. We conduct experiments on multiple EEG feature encoders and two clinically relevant downstream tasks using publicly available large-scale clinical EEGs. Within this experimental setting, our results suggest that measures of latent space integrity and model uncertainty under the proposed data shifts may help anticipate performance degradation during deployment. 

Machine learning (ML)-based analysis of electroencephalograms (EEGs) is playing an important role in advancing neurological care. However, the difficulties in automatically extracting useful metadata from clinical records hinder the development of large-scale EEG-based ML models. EEG reports, which are the primary sources of metadata for EEG studies, suffer from lack of standardization. Here we propose a machine learning-based system that automatically extracts attributes detailed in the SCORE specification from unstructured, natural-language EEG reports. Specifically, our system, which jointly utilizes deep learning- and rule-based methods, identifies (1) the type of seizure observed in the recording, per physician impression; (2) whether the patient was diagnosed with epilepsy or not; (3) whether the EEG recording was normal or abnormal according to physician impression. We performed an evaluation of our system using the publicly available Temple University EEG corpus and report F1 scores of 0.93, 0.82, and 0.97 for the respective tasks. 

This paper presents a domain-guided approach for learning representations of scalp-electroencephalograms (EEGs) without relying on expert annotations. Expert labeling of EEGs has proven to be an unscalable process with low inter-reviewer agreement because of the complex and lengthy nature of EEG recordings. Hence, there is a need for machine learning (ML) approaches that can leverage expert domain knowledge without incurring the cost of labor-intensive annotations. Self-supervised learning (SSL) has shown promise in such settings, although existing SSL efforts on EEG data do not fully exploit EEG domain knowledge. Furthermore, it is unclear to what extent SSL models generalize to unseen tasks and datasets. Here we explore whether SSL tasks derived in a domain-guided fashion can learn generalizable EEG representations. Our contributions are three-fold: 1) we propose novel SSL tasks for EEG based on the spatial similarity of brain activity, underlying behavioral states, and age-related differences; 2) we present evidence that an encoder pretrained using the proposed SSL tasks shows strong predictive performance on multiple downstream classifications; and 3) using two large EEG datasets, we show that our encoder generalizes well to multiple EEG datasets during downstream evaluations.